EQUINE GRASS SICKNESS FUND

ON-LINE CASE FORM

If you have had a case of grass sickness, please complete this form.
If you prefer not to include your name or full address, please give the nearest town or the county.

Name:
Address:
County:
Postcode:
Telephone:
Email:
Name of horse/pony:
Age:
Sex:
Breed:
Are you the owner ? Tick here if yes
When did Grass
Sickness occur ?
Nearest town to where
the horse was kept
when it became ill:
Was it: Acute GS     Subacute GS     Chronic GS
Did the horse/pony: a) Die If yes, was EGS confirmed by post mortem ? Tick if yes
b) Survive If yes, was it able to work after being ill ? Tick if yes
Doing what ?
Any long lasting
problems ?
Your comments or
observations :

The information submitted in this form will be treated in strictest confidence and will not be used for any purposes other than in connection with research into Equine Grass Sickness.

If you do not wish to submit this form on-line but would prefer to post it to us, please CLICK HERE to print out a copy.